Kardiyak Arrest Sonrası Spontan Dolaşımı Geri Dönen Hastalarda Hedefe Yönelik Hipotermi Uygulamasının Etkileri

Savaş Altınsoy; Fatma Kavak Akelma; Sibel Çatalca; Mukaddes Arslan; Derya Özkan; Mehmet Murat Sayın; Julide Ergil

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Kardiyak Arrest Sonrası Spontan Dolaşımı Geri Dönen Hastalarda Hedefe Yönelik Hipotermi Uygulamasının Etkileri

Year 2020, Volume: 3 Issue: 1, 1 - 12, 30.04.2020

Savaş Altınsoy Fatma Kavak Akelma Sibel Çatalca Mukaddes Arslan Derya Özkan Mehmet Murat Sayın Julide Ergil

Abstract

Giriş: Kardiyak arrest sıklıklıkla ölüm ile sonuçlanan bir tablodur. Bununla birlikte, arrest sonrası spontan dolaşımın geri dönen (SDGD) hastaların hastaneden taburculuk oranları oldukça düşüktür. Hedefe yönelik hipotermi (HYH) kardiyak arrest sonrası vücut sıcaklığının kontrollü bir şekilde sabit tutulduğu ve nörolojik açıdan iyi prognostik göstergelere sahip ol an bir uygulamadır. Bu çalışmada HYH uygulanan ve uygulanmayan hastaların 30 günlük mortalite oranlarını, mortalite öngörüsü sağladığı düşünülen hastalara ait hastalara ait nötrofil lenfosit oranı (NLO), laktat ve prokalsitonin (PCT) değerleri karşılaştırmak amaçlandı.
Gereç-Yöntem: Etik kurul onayı alındıktan sonra yoğun bakım ünitesinde kardiyak arrest tanısı ile yatan hastaların dosyaları tarandı. Hastalara ait yaş, cinsiyet gibi demografik özellikler, yatış zamanı, resüsitasyon süresi, tanı esnasındaki ritim tipi, eşlik eden hastalıklar, APACHE ve SOFA skorları, yoğun bakım ve hastane süreleri kayıt edildi. Serum PCT, laktat, laktat klirensi, Nötrofil, lenfosit, NLO ve beyaz küre değerleri SDGD anda (T1), 24. Saatte (T2), 48. Saatte (T3) ve 72. Saatte (T4) kayıt altına alındı.
Bulgular: Demografik özellikler bakımından (yaş, cinsiyet ve vücut kitle indeksi) gruplar benzerdi. Resusistasyon süresi bakımından grup TH grup N-TH’den anlamlı olarak daha kısa idi. APACHE ve SOFA skorları kıyaslandığında grup TH’de daha düşük bulundu. Gruplar arasında PCT düzeyleri bakımından sadece T1, T2 ve T3 zaman diliminlerinde, serum laktat, nötrofil ve lenfosit sayıları ise T2 zaman diliminde grup TH’de daha düşük bulundu. Yaşayan ve yaşamayan hastalar kıyaslandığında yaşanlarda PCT, laktat ve NLO değerleri daha düşük olduğu görüldü.
Tartışma Sonuç: Çalışmanın sonucunda ilk 30 günde HYH uygulanan daha fazla hastanın yaşadığı ile NLO, PCT ve laktat değerlerinin daha düşük olduğu gözlendi. Uygun endikasyon ve protokol ile uygulanan HYH 30 günlük mortaliteyi azaltabilir ve bu uygulama esnasında prognostik öngörü için NLO, PCT ve laktat değerleri kulanılabilir.

Keywords

Hedefe yönelik hipoter, nötrofil lenfosit oranı, laktat, laktat klirensi, prokalsitonin, mortalite

Supporting Institution

yok

Project Number

yok

References

1. Patel VH, Vendittelli P, Garg R, et al. Neutrophil-lymphocyte ratio: A prognostic tool in patients with in-hospital cardiac arrest. World J Crit Care Med 2019; 8(2): 9-17.
2. Cocchi MN, Salciccioli J, Yankama T, et al. Predicting Outcome After Out-of-Hospital Cardiac Arrest: Lactate, Need for Vasopressors, and Cytochrome c. J Intensive Care Med 2019: 885066619873315.
3. Nadkarni VM, Larkin GL, Peberdy MA, et al. First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA 2006; 295(1): 50-7.
4. Booth CM, Boone RH, Tomlinson G, et al. Is this patient dead, vegetative, or severely neurologically impaired? Assessing outcome for comatose survivors of cardiac arrest. JAMA 2004; 291(7): 870-9.
5. Doshi P, Patel K, Banuelos R, et al. Effect of Therapeutic Hypothermia on Survival to Hospital Discharge in Out-of-hospital Cardiac Arrest Secondary to Nonshockable Rhythms. Acad Emerg Med 2016; 23(1): 14-20.
6. Garcia S, Drexel T, Bekwelem W, et al. Early Access to the Cardiac Catheterization Laboratory for Patients Resuscitated From Cardiac Arrest Due to a Shockable Rhythm: The Minnesota Resuscitation Consortium Twin Cities Unified Protocol. J Am Heart Assoc 2016; 5(1).
7. Kim HJ, Park KN, Kim SH, et al. Association between the neutrophil-to-lymphocyte ratio and neurological outcomes in patients undergoing targeted temperature management after cardiac arrest. J Crit Care 2018; 47: 227-31.
8. Weiser C, Schwameis M, Sterz F, et al. Mortality in patients resuscitated from out-of-hospital cardiac arrest based on automated blood cell count and neutrophil lymphocyte ratio at admission. Resuscitation 2017; 116: 49-55.
9. Samborska-Sablik A, Sablik Z, Gaszynski W. The role of the immuno-inflammatory response in patients after cardiac arrest. Arch Med Sci 2011; 7(4): 619-26.
10. Sulaj M, Saniova B, Drobna E, et al. Serum neuron specific enolase and malondialdehyde in patients after out-of-hospital cardiac arrest. Cell Mol Neurobiol 2009; 29(6-7): 807-10.
11. Hachimi-Idrissi S, Van der Auwera M, Schiettecatte J, et al. S-100 protein as early predictor of regaining consciousness after out of hospital cardiac arrest. Resuscitation 2002; 53(3): 251-7.
12. Chen H, Wu F, Yang P, et al. A meta-analysis of the effects of therapeutic hypothermia in adult patients with traumatic brain injury. Crit Care 2019; 23(1): 396.
13. Okazaki T, Hifumi T, Kawakita K, et al. Japanese Association for Acute Medicine out-of-hospital cardiac arrest r. Targeted temperature management guided by the severity of hyperlactatemia for out-of-hospital cardiac arrest patients: a post hoc analysis of a nationwide, multicenter prospective registry. Ann Intensive Care 2019; 9(1): 127.
14. Açıkalın A GM, Acehan S, Sebe A. Terapötik Hipotermi. Arşiv Kaynak Tarama Dergisi 2011; 20(1): 20-35.
15. Kraut JA, Madias NE. Lactic acidosis. N Engl J Med 2014; 371(24): 2309-19.
16. Dell'Anna AM, Sandroni C, Lamanna I, et al. Prognostic implications of blood lactate concentrations after cardiac arrest: a retrospective study. Ann Intensive Care 2017; 7(1): 101.
17. Mullner M, Sterz F, Domanovits H, et al. The association between blood lactate concentration on admission, duration of cardiac arrest, and functional neurological recovery in patients resuscitated from ventricular fibrillation. Intensive Care Med 1997; 23(11): 1138-43.
18. Bellomo R, Martensson J, Eastwood GM. Metabolic and electrolyte disturbance after cardiac arrest: How to deal with it. Best Pract Res Clin Anaesthesiol 2015; 29(4): 471-84.
19. Orban JC, Novain M, Cattet F, et al. Association of serum lactate with outcome after out-of-hospital cardiac arrest treated with therapeutic hypothermia. PLoS One 2017; 12(3): e0173239.
20. Saliba W, Barnett-Griness O, Elias M, et al. Neutrophil to lymphocyte ratio and risk of a first episode of stroke in patients with atrial fibrillation: a cohort study. J Thromb Haemost 2015; 13(11): 1971-9.
21. Sawant AC, Adhikari P, Narra SR, et al. Neutrophil to lymphocyte ratio predicts short- and long-term mortality following revascularization therapy for ST elevation myocardial infarction. Cardiol J 2014; 21(5): 500-8.
22. Avci A, Elnur A, Goksel A, et al. The relationship between neutrophil/lymphocyte ratio and calcific aortic stenosis. Echocardiography 2014; 31(9): 1031-5.
23. Nielsen N, Wetterslev J, Cronberg T, et al. Targeted temperature management at 33 degrees C versus 36 degrees C after cardiac arrest. N Engl J Med 2013; 369(23): 2197-206.
24. Geurts M, Macleod MR, Kollmar R, et al. Therapeutic hypothermia and the risk of infection: a systematic review and meta-analysis. Crit Care Med 2014; 42(2): 231-42.
25. S. Demirgan KE, M. S. Sevdi, M. Türkay, et al. Retrospective evaluation of the effect of therapeutic hypothermia application on infectious complications. The Medical Bulltein of Şişli Etfal Hospital 2015; 49(2): 122-30.
26. Choi JJ, McCarthy MW. Novel applications for serum procalcitonin testing in clinical practice. Expert Rev Mol Diagn 2018; 18(1): 27-34.
27. Taylor R, Jones A, Kelly S, et al. A Review of the Value of Procalcitonin as a Marker of Infection. Cureus 2017; 9(4): e1148.
28. AlRawahi AN, AlHinai FA, Doig CJ, et al. The prognostic value of serum procalcitonin measurements in critically injured patients: a systematic review. Crit Care 2019; 23(1): 390.
29. Isenschmid C, Kalt J, Gamp M, et al. Routine blood markers from different biological pathways improve early risk stratification in cardiac arrest patients: Results from the prospective, observational COMMUNICATE study. Resuscitation 2018; 130: 138-45.
30. Shin H, Kim JG, Kim W, et al. Procalcitonin as a prognostic marker for outcomes in post-cardiac arrest patients: A systematic review and meta-analysis. Resuscitation 2019; 138: 160-7.
31. Krzych LJ, Golab K, Pstras J, et al. Predicting outcome after cardiac arrest with serum S-100B protein and procalcitonin: A prospective observational study. Eur J Anaesthesiol 2017; 34(12): 846-8.

Year 2020, Volume: 3 Issue: 1, 1 - 12, 30.04.2020

Savaş Altınsoy Fatma Kavak Akelma Sibel Çatalca Mukaddes Arslan Derya Özkan Mehmet Murat Sayın Julide Ergil

Abstract

Project Number

yok

References

1. Patel VH, Vendittelli P, Garg R, et al. Neutrophil-lymphocyte ratio: A prognostic tool in patients with in-hospital cardiac arrest. World J Crit Care Med 2019; 8(2): 9-17.
2. Cocchi MN, Salciccioli J, Yankama T, et al. Predicting Outcome After Out-of-Hospital Cardiac Arrest: Lactate, Need for Vasopressors, and Cytochrome c. J Intensive Care Med 2019: 885066619873315.
3. Nadkarni VM, Larkin GL, Peberdy MA, et al. First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA 2006; 295(1): 50-7.
4. Booth CM, Boone RH, Tomlinson G, et al. Is this patient dead, vegetative, or severely neurologically impaired? Assessing outcome for comatose survivors of cardiac arrest. JAMA 2004; 291(7): 870-9.
5. Doshi P, Patel K, Banuelos R, et al. Effect of Therapeutic Hypothermia on Survival to Hospital Discharge in Out-of-hospital Cardiac Arrest Secondary to Nonshockable Rhythms. Acad Emerg Med 2016; 23(1): 14-20.
6. Garcia S, Drexel T, Bekwelem W, et al. Early Access to the Cardiac Catheterization Laboratory for Patients Resuscitated From Cardiac Arrest Due to a Shockable Rhythm: The Minnesota Resuscitation Consortium Twin Cities Unified Protocol. J Am Heart Assoc 2016; 5(1).
7. Kim HJ, Park KN, Kim SH, et al. Association between the neutrophil-to-lymphocyte ratio and neurological outcomes in patients undergoing targeted temperature management after cardiac arrest. J Crit Care 2018; 47: 227-31.
8. Weiser C, Schwameis M, Sterz F, et al. Mortality in patients resuscitated from out-of-hospital cardiac arrest based on automated blood cell count and neutrophil lymphocyte ratio at admission. Resuscitation 2017; 116: 49-55.
9. Samborska-Sablik A, Sablik Z, Gaszynski W. The role of the immuno-inflammatory response in patients after cardiac arrest. Arch Med Sci 2011; 7(4): 619-26.
10. Sulaj M, Saniova B, Drobna E, et al. Serum neuron specific enolase and malondialdehyde in patients after out-of-hospital cardiac arrest. Cell Mol Neurobiol 2009; 29(6-7): 807-10.
11. Hachimi-Idrissi S, Van der Auwera M, Schiettecatte J, et al. S-100 protein as early predictor of regaining consciousness after out of hospital cardiac arrest. Resuscitation 2002; 53(3): 251-7.
12. Chen H, Wu F, Yang P, et al. A meta-analysis of the effects of therapeutic hypothermia in adult patients with traumatic brain injury. Crit Care 2019; 23(1): 396.
13. Okazaki T, Hifumi T, Kawakita K, et al. Japanese Association for Acute Medicine out-of-hospital cardiac arrest r. Targeted temperature management guided by the severity of hyperlactatemia for out-of-hospital cardiac arrest patients: a post hoc analysis of a nationwide, multicenter prospective registry. Ann Intensive Care 2019; 9(1): 127.
14. Açıkalın A GM, Acehan S, Sebe A. Terapötik Hipotermi. Arşiv Kaynak Tarama Dergisi 2011; 20(1): 20-35.
15. Kraut JA, Madias NE. Lactic acidosis. N Engl J Med 2014; 371(24): 2309-19.
16. Dell'Anna AM, Sandroni C, Lamanna I, et al. Prognostic implications of blood lactate concentrations after cardiac arrest: a retrospective study. Ann Intensive Care 2017; 7(1): 101.
17. Mullner M, Sterz F, Domanovits H, et al. The association between blood lactate concentration on admission, duration of cardiac arrest, and functional neurological recovery in patients resuscitated from ventricular fibrillation. Intensive Care Med 1997; 23(11): 1138-43.
18. Bellomo R, Martensson J, Eastwood GM. Metabolic and electrolyte disturbance after cardiac arrest: How to deal with it. Best Pract Res Clin Anaesthesiol 2015; 29(4): 471-84.
19. Orban JC, Novain M, Cattet F, et al. Association of serum lactate with outcome after out-of-hospital cardiac arrest treated with therapeutic hypothermia. PLoS One 2017; 12(3): e0173239.
20. Saliba W, Barnett-Griness O, Elias M, et al. Neutrophil to lymphocyte ratio and risk of a first episode of stroke in patients with atrial fibrillation: a cohort study. J Thromb Haemost 2015; 13(11): 1971-9.
21. Sawant AC, Adhikari P, Narra SR, et al. Neutrophil to lymphocyte ratio predicts short- and long-term mortality following revascularization therapy for ST elevation myocardial infarction. Cardiol J 2014; 21(5): 500-8.
22. Avci A, Elnur A, Goksel A, et al. The relationship between neutrophil/lymphocyte ratio and calcific aortic stenosis. Echocardiography 2014; 31(9): 1031-5.
23. Nielsen N, Wetterslev J, Cronberg T, et al. Targeted temperature management at 33 degrees C versus 36 degrees C after cardiac arrest. N Engl J Med 2013; 369(23): 2197-206.
24. Geurts M, Macleod MR, Kollmar R, et al. Therapeutic hypothermia and the risk of infection: a systematic review and meta-analysis. Crit Care Med 2014; 42(2): 231-42.
25. S. Demirgan KE, M. S. Sevdi, M. Türkay, et al. Retrospective evaluation of the effect of therapeutic hypothermia application on infectious complications. The Medical Bulltein of Şişli Etfal Hospital 2015; 49(2): 122-30.
26. Choi JJ, McCarthy MW. Novel applications for serum procalcitonin testing in clinical practice. Expert Rev Mol Diagn 2018; 18(1): 27-34.
27. Taylor R, Jones A, Kelly S, et al. A Review of the Value of Procalcitonin as a Marker of Infection. Cureus 2017; 9(4): e1148.
28. AlRawahi AN, AlHinai FA, Doig CJ, et al. The prognostic value of serum procalcitonin measurements in critically injured patients: a systematic review. Crit Care 2019; 23(1): 390.
29. Isenschmid C, Kalt J, Gamp M, et al. Routine blood markers from different biological pathways improve early risk stratification in cardiac arrest patients: Results from the prospective, observational COMMUNICATE study. Resuscitation 2018; 130: 138-45.
30. Shin H, Kim JG, Kim W, et al. Procalcitonin as a prognostic marker for outcomes in post-cardiac arrest patients: A systematic review and meta-analysis. Resuscitation 2019; 138: 160-7.
31. Krzych LJ, Golab K, Pstras J, et al. Predicting outcome after cardiac arrest with serum S-100B protein and procalcitonin: A prospective observational study. Eur J Anaesthesiol 2017; 34(12): 846-8.

There are 31 citations in total.

Details

Primary Language	Turkish
Subjects	Anaesthesiology
Journal Section	Articles
Authors	Savaş Altınsoy Fatma Kavak Akelma Sibel Çatalca This is me 0000-0002-8899-1106 Mukaddes Arslan Derya Özkan 0000-0002-8964-3015 Mehmet Murat Sayın This is me 0000-0003-3479-6185 Julide Ergil
Project Number	yok
Publication Date	April 30, 2020
Acceptance Date	March 30, 2020
Published in Issue	Year 2020 Volume: 3 Issue: 1

Cite

APA	Altınsoy, S., Kavak Akelma, F., Çatalca, S., Arslan, M., et al. (2020). Kardiyak Arrest Sonrası Spontan Dolaşımı Geri Dönen Hastalarda Hedefe Yönelik Hipotermi Uygulamasının Etkileri. Journal of Cukurova Anesthesia and Surgical Sciences, 3(1), 1-12.

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